Why we must invest in our future nursing leaders

Nursing is my past, present and future. After a twelve-year career as an actor, I now follow in my registered nurse mother’s footsteps, working as an early-career public health community staff nurse with newly arrived asylum seekers, some of our society’s most disadvantaged members.

I believe we must invest in tomorrow’s nursing leaders because we are the future and beating heart of our profession, requiring courtesy and kindness yet boldness and insistence. While we welcome experienced mentorship, we can provide reverse-mentoring through partnership-working, bringing fresh perspectives to creative problem solving for the many issues faced in healthcare.

Additionally, as future leaders, we can provide peer support, learning from international best practice. As nurses, we are one of the only healthcare professions there 24 hours a day, seven days a week, 365 days a year, allowing us to intimately and holistically know those we serve on individual and population levels. Therefore, we can advocate in a way no other profession can, making us prime drivers for change. This change must be individualised, person-centred and co-produced with communities, involving empowerment, role-modelling, training projects and public health education and promotion, enabling disease prevention.

All United Nations (U.N., 2015) Member States committed to 17 Sustainable Development Goals, uniting them in global partnership to address global health issues. As future leaders, we have the capabilities, power and tools to be authentic and effective agents for social change. We can propel forwards the agendas of addressing global health injustice, eradicating global health inequalities, and achieving universal health coverage for all.

Coming from a high-income country, I am acutely aware we have much to learn from lower and middle-income countries, from the innovative and revolutionary initiatives they have implemented, as the State of the World’s Nursing Report highlights (World Health Organization (WHO), 2020). However, we are also ethically obliged to help others as a resource-rich nation (Campbell, Pleic and Connelly, 2012). Global working requires future nurse leaders to be inclusive and inclusively literate, pertinent as nursing education, fields and specialities vary significantly internationally.

Covid-19 exposed that healthcare systems, locally, nationally and globally, were unprepared. And while individual nurses require the ability to recover from difficult situations, anecdotal evidence suggests a co-opting of the terminology “resilience”. We often see the term resilience used as a weapon against individual nurses, diverting from systematic failings, causing individuals to experience internalised guilt, feelings of inadequacy, and I am confident sometimes preventing disclosure. It is victim-blaming and potentially gaslighting. If individuals cannot bounce back, there can be the perception they are not strong enough to be nurses. Attitudes must change. Because when the adrenaline of managing the pandemic wears off, systems will question individual nurse’s resilience if they struggle with potential physical, emotional and psychological fallout and trauma.

Instead, future nurse leaders need to help cultivate and develop emotionally intelligent, reflective practitioners who advocate for healthcare systems that operate likewise. Additionally, we must become more proactive and less reactive as a profession, demanding protected time for continuing professional development and restorative clinical supervision. Our future nursing leaders must fight to enhance our professional status. We need more nurse specialists, researchers and further investment in advanced nursing services. Most importantly, we need to see ourselves as leaders. If we do not, how can we expect other healthcare professionals to see us this way? We must use the lived and empirical evidence we have accrued as nurses to exhibit these leadership capabilities while working collaboratively with our interprofessional colleagues to achieve global health goals.

I hope by focussing on these suggestions, we encourage all nursing professionals to develop and flourish, addressing the four pillars of clinical practice, leadership and management, education, and research. To do so, we need to enable, empower and educate our early-career nurses and students to harness each of these. Too often, we tell these individuals only to focus on clinical practice, or they have little knowledge of the other pillars and how to develop their careers accordingly. This thinking is detrimental to our profession, as we should celebrate nursing in all its multi-faceted glory.

I believe, to achieve this goal, much has to change. We must be cognisant of “toxic positivity” because perceived “negativity” is often essential to drive change when backed by evidence. Future nursing leaders have the power to do this. They must be campaigners and lobbyists who can intelligently influence on local, national and global stages. Governments, policymakers, non-governmental organisations and national and international nursing associations need to acknowledge and invest in the benefit of these opportunities for our profession. And we do this by illustrating how these changes will improve the population health of the communities we all serve. Our leaders must be present and heard in government to effect change.

Covid-19 has illustrated how reactive the nursing profession can be, but we need to invest in our workforce and education proactively. We already know retention of new registrants within their first two years is a significant issue, and pre-pandemic, we had global staffing shortages of nine million individuals (WHO, 2020). However, I worry this pandemic will exacerbate this, prompting a mass exodus of new registrants and near-retirement nurses unless we address potential emotional and psychological burnout.

Additionally, despite nurses and midwives making up fifty per cent of the healthcare workforce, our education receives only a quarter of the expenditure on healthcare education (WHO, 2020). Therefore, we must address safe staffing legislation and better pay, terms and conditions for our profession. Without the infrastructure to secure enough staff to support students, how can we encourage and nurture them to become future leaders? We have to inspire our future nursing leaders at all stages of their careers. Again, this requires us to be campaigners and lobbyists. We reach hearts by sharing the stories of those we care for as natural empaths. Then, we back this up with evidence regarding the human and health economic cost.

Craig Davidson RN

https://twitter.com/CraigDavidson85

REFERENCES

CAMPBELL, R.M., PLEIC, M. & CONNOLLY, H., 2012. The importance of a common global health definition: How Canada’s definition influences its strategic direction in global health. Journal of Global Health [online]. 2(1), pp. 1-6. [viewed 18 April 2021]. Available from: DOI: 10.7189/jogh.02.010301

UNITED NATIONS, 2015a. Sustainable Development Goals [online]. United Nations. [viewed 18 April 2021]. Available from: https://sustainabledevelopment.un.org/sdgs

WORLD HEALTH ORGANIZATION, 2020. State of the World’s Nursing Report – 2020 [online]. World Health Organization. [viewed 18 April 2021]. Available from: https://www.who.int/publications-detail/nursing-report-2020

Men into Nursing Campaigns: Why My Opinion Has Evolved.

I was very kindly asked to write this blog post for the Royal College of Nursing’s Feminist Network.

Fact: nursing is an evidenced-based profession; as we traverse throughout our university nursing education, we learn to be a nurse whilst honing our critical thinking skills.

When I took to the stage, speaking in favour of the resolution at the Royal College of Nursing’s (RCN) Congress 2018, “That this meeting of RCN Congress asks Council to develop and promote a strategy to recruit more men into the nursing profession.”, I was a second-year university nursing student. I was in my first term as one of the Scottish representatives on the RCN Students’ Committee before taking over as committee chair in January 2019. At the time, I argued:

“Nursing is one of the most important professions in the world. At some point in their lives, everyone, whether directly or through a loved one, will come in contact with a nurse. It takes a very particular kind of person to be a nurse. They don’t do it for the fame; they certainly don’t do it for the fortune. It is something inherent within them. I was inspired to get into nursing by an extraordinary and inspirational nurse: my mum – a woman who has dedicated her entire working life to her patients and their families. I am proud to be a student nurse, and I cannot wait to be a nurse. But, I do not consider myself a male student nurse. I will not be a male nurse. However, I am passionate about getting more men into nursing, the right men who have the necessary values to be nurses. The reason: I believe the nursing workforce must be as diverse as the communities we serve in terms of gender, ethnicity and race, sexuality, gender and sexual orientation, and all other protected characteristics. At the moment, it is not. I want to promote nursing as a wonderful, rewarding career for all. And I want to encourage men into nursing who may not know it is a viable career option for them.

Eleven per cent of nurses are male; this figure has been largely unchanged since the 1980s. However, the idea of a campaign to recruit men into nursing has raised some serious debate. Undeniably, there is a serious disparity of men at senior management and professoriate level in nursing; this is an issue that must be addressed. We need to establish why this is happening. That being said, the proposed campaign to recruit men into nursing is concerned with the number of men working at grassroots, Band 5 level; the nurses who interact with patients and their families on a day-to-day basis. So, I believe it is essential we do not conflate these two issues. We won’t solve one problem by ignoring another. We need to diversify the nursing workforce, and we need to do it now.

How do we do this? Personally, I don’t believe we should be giving scholarships or grants to attract men into nursing. Women, remarkable women, have paved the way in our profession for years, which we should be immensely proud of and celebrate. It would be a disservice to these women, and all women, to positively discriminate men in this way. I think we can solve the issue of the disparity at senior levels and attract more men into nursing in the same way.

Nursing needs a serious image overhaul. We need to educate the public about what it means to be a nurse and what we do. Too often, we still hear that nursing is “women’s work” or that if you are clever, you should push yourself into a career more difficult than nursing. I am deeply offended when I hear the latter. I had the grades to be a doctor; I chose to be a nurse. Nursing is a degree educated profession with many diverse career options. We need to showcase this and celebrate nursing as a career for all. The problem, I believe, is society’s view of women and “women’s work”. How do we change that?

We should be educating children from primary school age. We have generations of societal views to change, and this is where opinions are formed. We need to have nurses and student nurses from all backgrounds and genders going into primary and secondary schools. Have them meet modern nurses. That way, we will hopefully encourage not only more young boys but more young girls into nursing”.

Whilst I still agree with some of what I originally stated; I have come to realise, as I have honed my critical thinking skills and educated myself further on women’s issues in nursing and society in general, that my views were, to put it mildly, utopian, and more strongly, damaging to women. Something I am disappointed in, as I consider myself a feminist ally, something I have discussed at length in previous blog posts and recurringly throughout my podcast with fellow registered nurse Clare Manley, “Retaining the Passion: Journeys Through Nursing.”

Reflecting on my Congress argument, I am horrified that my original statement encroached on the “vocational” nursing element, something I now vehemently argue against. Who did I think I was, Nadine Dorries? Nursing is a highly-skilled, evidence-based profession, deserving of proper remuneration with robust and strengthened terms and conditions. However, I still think that the nursing workforce needs to reflect the communities we serve, particularly at the grassroots level. Of that, my viewpoint remains unchanged.

Examples of where I believe the profession could benefit from more nurses who happen to be men include specific mental health services. Men make up three-quarters of all suicides: fact. And there is anecdotal and empirical evidence that some, not all, men prefer to be treated by nurses who are men, particularly heterosexual men who have similar lived experiences. I understand this.

I have also borne witness, working both as a student and registered nurse, to situations where a female patient is quite rightly always offered to choose whether to receive personal care or to be catheterised, for example, from a nurse who happens to be male or female. Many of whom prefer to choose a female. I do not take offence to this. And it is something I completely agree with, especially due to the increase in violence against women. But due to the lack of nurses, who happen to be men, working in patient-facing roles, this same choice is rarely given to male patients, as it is not always physically possible. There have been times when these men have told me they would prefer to be treated by a man but have been unable to be. Ultimately, should everything we do not come down to patient choice?

Another potential argument I was made aware of is that there is empirical evidence that by having more men enter the nursing workforce, we see real-time increases in pay, terms and conditions. Interestingly, when I had an educational exchange placement between my second and third year as a student in the United States, many female nurses, including senior female Professors of Nursing, who were members of the American Nurses Association, amongst other unions, were shocked that we in the UK were not proactively pushing for more men to enter the profession, as they had seen these real-time improvements Stateside. A good argument, I thought. However, again, as I have become more critical and made myself more educated, whilst this has had this effect Stateside, it has also had the detrimental effect of pushing women out of a field of work they never thought was “beneath them”. So, surely this cannot be the correct answer?

Throughout my five years of being a nursing student and now a registered nurse, I have learned that this is an incredibly nuanced argument. But I genuinely believe it is one we are addressing wrongly. Men should not be seen as an untapped workforce to plug our recruitment gaps. We are not the “white knights” who will ride in to save the profession. We are not a minority population we should be catering for, and we most definitely should not be “butching up” the profession to get more men to enter it. Those recruitment videos of manly men running around accident and emergency departments physically make me cringe. Women have never seen nursing as beneath them; men have. Society has taught men to because of society’s view and value of women’s work, and we must address that problem, which was one of my original 2018 arguments that remains unchanged.

As my opinion of men in nursing campaigns has evolved, I have gotten into many arguments on social media with fellow nurses who happen to be men, those I used to and still respect. And, subsequently, I have been unfollowed by many in their droves. Luckily, I am not that thin-skinned. But I would rather stand alongside my nursing sisters; acknowledge their issues, and fight for the nursing profession to be recognised for exactly how amazing it is. If that brings more men into the profession, then great. But it should not be our focus. And it never should have been.

Craig Davidson RN BSc (Hons)

https://twitter.com/CraigDavidson85

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